MEDICARE: WESLEY ALEXANDER GRAY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03439022	OH

General Provider Information

NPI Number	:	1427645845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY ALEXANDER GRAY PHARMD

Provider Business Mailing Address
First Line	:	1211 CHAMBERS RD APT 308
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-2555
Country	:	US
Telephone Number	:	614-263-9424
Fax Number	:	614-263-2929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2020
Last Update Date	:	12/31/2020

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